Provider Demographics
NPI:1023271970
Name:SPINE DYNAMICS, INC.
Entity type:Organization
Organization Name:SPINE DYNAMICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CATO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-741-2187
Mailing Address - Street 1:701 ENFIELD ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2961
Mailing Address - Country:US
Mailing Address - Phone:860-741-2187
Mailing Address - Fax:860-741-2188
Practice Address - Street 1:701 ENFIELD ST
Practice Address - Street 2:SUITE 170
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2961
Practice Address - Country:US
Practice Address - Phone:860-741-2187
Practice Address - Fax:860-741-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCT15480OtherLANDMARK
CT659634OtherUHC, HNE, ACN
CTP00271268OtherRAILROAD MEDICARE
CT105007OtherASHN
CTP3240793OtherOXFORD HEALTH PLAN
CT050001548CT01OtherANTHEM BCBS
CT7127580OtherAETNA
CT9385151OtherPHCS
CT105007OtherASHN